Evaluating breastfeeding support : a randomised controlled trial of support from breastfeeding counsellors

Two-thirds of UK mothers begin breastfeeding, but many soon stop. Although breastfeeding benefits health, infant feeding is influenced by social and attitudinal factors. Study one prospectively investigated the attitudes and experiences of 514 women. Past experience predicted which multiparae would stop by six weeks. Manual social class and considering bottle feeding did so for primiparae. Perceived insufficient milk was the commonest reason for stopping. Study two, a randomised trial of support from breastfeeding counsellors, recruited 720 women. At four months, 46.1% (143/310) intervention and 42.3% (131/310) control women breastfed (Chi\(^2\)=0.942, P=0.33); 73.9% (229/310) vs 79.4% (246/310) gave bottle feeds (Chi\(^2\)=2.60, P=0.11). Survival analysis confirmed that differences between intervention and control women's partial and full breastfeeding duration were not significant (P=0.45 and 0.15 respectively.) Significantly fewer intervention women felt they had insufficient milk. Qualitative analysis of women’s comments revealed they wanted better information, practical help with positioning, effective advice, encouragement and their feelings acknowledged. Women valued counselling, but their feeding behaviour changed little, which may reflect the strength of social influences and that not all mothers contacted the counsellors postnatally. Practical support in the early postnatal period is important. Counselling may increase women's confidence in breastfeeding and producing enough milk